§1205. Claim for payments; privilege of employee; non-assignability; exemption from seizure; payment of denied medical expenses
A. Claims or payments due under this Chapter shall have the same preference and priority for the whole thereof against the assets of the employer as is allowed by law for any unpaid wages of the laborer; and shall not be assignable, and shall be exempt from all claims of creditors and from levy or execution or attachment or garnishment, except under a judgment for alimony in favor of a wife, or an ascendant or descendant.
B. Any company which contracts for health care benefits for an employee shall have a right of reimbursement against the entity responsible for the payment of workers' compensation benefits for such employee if the company paid health care benefits for which such entity is liable. The amount of reimbursement shall not exceed the amount of the entity's liability for the workers' compensation benefit. In the event the company seeks recovery for such in conjunction with a claim against any other party brought by the employee, the company may be charged with a proportionate share of the reasonable and necessary costs, including attorney fees, incurred by the employee in the advancement of his claim or suit.
C.(1) In the event that the workers' compensation payor has denied that the employee's injury is compensable under this Chapter, then any health insurer which contracts to provide health care benefits for an employee shall be responsible for the payment of all medical benefits pursuant to the terms of the health insurer's policy. Any health insurer which contracts to provide health care benefits for an employee who violates the provisions of this Subsection shall be liable to the employee or health care provider for reasonable attorney fees and costs related to the dispute and to the employee for any health benefits payable.
(2) The payment of medical expenses shall be recoverable pursuant to and in accordance with Subsection B of this Section. However, if it is determined that the worker's compensation payor was responsible for payment of medical benefits that have been paid by the health insurer, the obligation of the worker's compensation payor for such benefits shall be to reimburse the health insurer one hundred percent of the benefits it paid. If it is determined that the worker's compensation payor was responsible for payment of benefits and its denial of responsibility is determined to be arbitrary and capricious, then the health insurer shall also be entitled to recover legal interest on any benefits it paid, calculated from the date such benefits were due.
(3) Any claim filed against the worker's compensation carrier by the health insurer or health providers in accordance with this provision shall not be subject to timely filing requirements, nor does prescription run until such time as the workers' compensation claim reaches a resolution by final judgment or settlement.
(4) Any claim filed by a health care provider against a health insurer pursuant to this Section shall be filed no later than one hundred eighty days after the denial by the worker's compensation payor.
Acts 1995, No. 449, §1; Acts 2004, No. 554, §1.
Notes of Decisions
Rebel Distributors Corp. v. Luba Workers' Comp., 144 So. 3d 825 (La. 2013).
· cites it 33× “R.S. 23:1205 has consistently recognized that the prohibition against assignment of claims or payments due prevents an injured employee from assigning his or her claims or payments due.”
Ryan v. Blount Bros. Const., Inc., 927 So. 2d 1242 (La. Ct. App. 2006).
· cites it 10× “18, pursuant to LSA-R.S. 23:1205, which provides in pertinent part: * * * B.”
Olivier v. City of Eunice, 92 So. 3d 630 (La. Ct. App. 2012).
· cites it 5× “R.S. 23:1205, which provides health insurers that have paid medical expenses for injured employees a right of reimbursement for 100% of medical expenses against employers responsible for workers’ compensation benefits.”
Rebel Distributors Corp. v. LUBA Workers' Comp., 137 So. 3d 91 (La. Ct. App. 2014).
· cites it 2× “Heard/Clinic to convert the original assignment agreement into a retroactive agency agreement did not qualify as an express novation sufficient to accomplish the intended result.”
Chailland Bus. Consultants v. Duplantis, 897 So. 2d 117 (La. Ct. App. 2004).
· cites it 16× “The Court also finds that pursuant to LSA-R.S. 23:1205, the intervenor, Principal Life Insurance Company, is entitled to be reimbursed by defendant, Chailland Business Consultants, for medical expenses paid in the treatment of the catastrophic injuries sustained by Larry…”
Deville v. South Cent. Indus., Inc., 764 So. 2d 335 (La. Ct. App. 2000).
· cites it 6× “R.S. 23:1205 B. Following a hearing on this issue, the workers' compensation judge found Blue Cross liable for a pro-rata portion of the attorney fees and costs associated with the prosecution of Deville's claim for compensation benefits.”
Koenig v. Christus Schumpert Health Sys., 12 So. 3d 1037 (La. Ct. App. 2009).
“R.S. 23:1205(C) was not utilized to try to resolve the "Catch 22” situation in which the claimant was ensnared by the private insurer's refusal to pay for the surgery because it deemed the matter to be an employment-related injury covered by workers’ compensation and the…”
Daniel v. Point to Point Directional Drilling, Inc., 139 So. 3d 613 (La. Ct. App. 2014).
· cites it 2× “R.S. 23:1205. Louisiana Revised Statutes 23:1205(B) provides: Any company which contracts for health care benefits for an employee shall have a right of reimbursement against the entity responsible for the payment of workers’ compensation benefits for such employee if the…”
Lebleu v. Deshotel, 628 So. 2d 1227 (La. Ct. App. 1993).
· cites it 5× “R.S. 23:1205 the benefits were not assignable.”
— La. Rev. Stat. § 23:1205(A) — 5 cases
Rebel Distributors Corp. v. Luba Workers' Comp., 144 So. 3d 825 (La. 2013).
“R.S. 23:1205 has consistently recognized that the prohibition against assignment of claims or payments due prevents an injured employee from assigning his or her claims or payments due.”
Rebel Distributors Corp. v. LUBA Workers' Comp., 137 So. 3d 91 (La. Ct. App. 2014).
“Heard/Clinic to convert the original assignment agreement into a retroactive agency agreement did not qualify as an express novation sufficient to accomplish the intended result.”
— La. Rev. Stat. § 23:1205(B) — 11 cases
Olivier v. City of Eunice, 92 So. 3d 630 (La. Ct. App. 2012).
“R.S. 23:1205, which provides health insurers that have paid medical expenses for injured employees a right of reimbursement for 100% of medical expenses against employers responsible for workers’ compensation benefits.”
Rebel Distributors Corp. v. Luba Workers' Comp., 144 So. 3d 825 (La. 2013).
“R.S. 23:1205 has consistently recognized that the prohibition against assignment of claims or payments due prevents an injured employee from assigning his or her claims or payments due.”
Chailland Bus. Consultants v. Duplantis, 897 So. 2d 117 (La. Ct. App. 2004).
“The Court also finds that pursuant to LSA-R.S. 23:1205, the intervenor, Principal Life Insurance Company, is entitled to be reimbursed by defendant, Chailland Business Consultants, for medical expenses paid in the treatment of the catastrophic injuries sustained by Larry…”
— La. Rev. Stat. § 23:1205(C) — 4 cases
Koenig v. Christus Schumpert Health Sys., 12 So. 3d 1037 (La. Ct. App. 2009).
“R.S. 23:1205(C) was not utilized to try to resolve the "Catch 22” situation in which the claimant was ensnared by the private insurer's refusal to pay for the surgery because it deemed the matter to be an employment-related injury covered by workers’ compensation and the…”
Chailland Bus. Consultants v. Duplantis, 897 So. 2d 117 (La. Ct. App. 2004).
“The Court also finds that pursuant to LSA-R.S. 23:1205, the intervenor, Principal Life Insurance Company, is entitled to be reimbursed by defendant, Chailland Business Consultants, for medical expenses paid in the treatment of the catastrophic injuries sustained by Larry…”
— La. Rev. Stat. § 23:1205(C)(1) — 1 case
Chailland Bus. Consultants v. Duplantis, 897 So. 2d 117 (La. Ct. App. 2004).
“The Court also finds that pursuant to LSA-R.S. 23:1205, the intervenor, Principal Life Insurance Company, is entitled to be reimbursed by defendant, Chailland Business Consultants, for medical expenses paid in the treatment of the catastrophic injuries sustained by Larry…”
— La. Rev. Stat. § 23:1205(C)(2) — 1 case
Chailland Bus. Consultants v. Duplantis, 897 So. 2d 117 (La. Ct. App. 2004).
“The Court also finds that pursuant to LSA-R.S. 23:1205, the intervenor, Principal Life Insurance Company, is entitled to be reimbursed by defendant, Chailland Business Consultants, for medical expenses paid in the treatment of the catastrophic injuries sustained by Larry…”
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